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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2017: 3.556

CiteScore 2017: 2.34

SCImago Journal Rank (SJR) 2017: 1.114
Source Normalized Impact per Paper (SNIP) 2017: 1.188

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1437-4331
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Volume 54, Issue 6

Issues

The impact of renal function on the clinical performance of FLC measurement in AL amyloidosis

Giovanni Palladini
  • Corresponding author
  • Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo”, Department of Molecular Medicine, University of Pavia, Pavia, Italy
  • Email
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  • De Gruyter OnlineGoogle Scholar
/ Paolo Milani
  • Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo”, Department of Molecular Medicine, University of Pavia, Pavia, Italy
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/ Andrea Foli
  • Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo”, Department of Molecular Medicine, University of Pavia, Pavia, Italy
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/ Marco Basset
  • Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo”, Department of Molecular Medicine, University of Pavia, Pavia, Italy
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/ Francesca Russo
  • Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo”, Department of Molecular Medicine, University of Pavia, Pavia, Italy
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/ Tiziana Bosoni / Laura Pirolini / Veronica Valentini
  • Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo”, Department of Molecular Medicine, University of Pavia, Pavia, Italy
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/ Giovanni Ferraro
  • Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo”, Department of Molecular Medicine, University of Pavia, Pavia, Italy
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/ Francesca Lavatelli
  • Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo”, Department of Molecular Medicine, University of Pavia, Pavia, Italy
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/ Alessandra Barassi
  • Department of Medicine, Surgery and Dentistry, Ospedale San Paolo, University of Milan, Milan, Italy
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/ Riccardo Albertini / Giampaolo Merlini
  • Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo”, Department of Molecular Medicine, University of Pavia, Pavia, Italy
  • Clinical Chemistry Laboratory, Foundation “IRCCS Policlinico San Matteo”, Pavia, Italy
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Published Online: 2016-03-04 | DOI: https://doi.org/10.1515/cclm-2015-0985

Abstract

Background: The measurement of circulating free light chains (FLC) is of utmost importance in immunoglobulin light chain (AL) amyloidosis, being a fundamental part of the diagnostic workup, prognostic stratification and assessment of response to therapy. Renal failure is a common feature of AL amyloidosis and can considerably affect the concentration of FLC.

Methods: We assessed the impact of renal failure on the clinical performance of the Freelite assay in 982 consecutive, newly diagnosed patients with AL amyloidosis, 822 with estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m2, and 160 with eGFR <30 mL/min/1.73 m2.

Results: The diagnostic sensitivity of the κ/λ FLC ratio was lower for λ amyloidogenic FLC in patients with renal failure (81% vs. 60%, p<0.001) and the FLC concentration had no independent prognostic significance in patients with severe renal dysfunction. However, FLC response to chemotherapy could still discriminate patients with better outcome.

Conclusions: Renal failure is a relevant interference factor when using the Freelite assay for the identification of the amyloidogenic light chain and for prognostic assessment in patients with AL amyloidosis and renal failure.

Keywords: amyloidosis; free light chains; renal failure

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About the article

Corresponding author: Giovanni Palladini, MD, PhD, Amyloidosis Research and Treatment Center, Foundation “Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo”, Department of Molecular Medicine, University of Pavia, Viale Golgi, 19 – 27100 Pavia, Italy, Phone: +39-0382-502994, Fax: +39-0382-502990


Received: 2015-10-09

Accepted: 2016-02-03

Published Online: 2016-03-04

Published in Print: 2016-06-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 54, Issue 6, Pages 939–945, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2015-0985.

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